Ss 1215-0105 (ca-1027) 10-27-09 -

SUPPORTING STATEMENT

REQUEST FOR EMPLOYMENT INFORMATION

1215-0105 (CA-1027)

                              

 

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collections. Attach a copy of the appropriate section of each statute and of each regulation mandating or authorizing the collection of information.

5 United States Code (U.S.C.) 8106 requires payment of compensation for partial disability to injured Federal employees.  That section also requires the Office of Workers' Compensation (OWCP) to obtain information regarding a claimant's earnings during a period of eligibility to compensation.  The CA-1027 is used to obtain earning information for an individual who is employed by a private employer.  This information is used to determine the claimant's entitlement to compensation benefits.

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

The information collected is used by claims examiners for OWCP to determine the appropriate level of benefits to be paid to a claimant.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden. 

In accordance with the Government Paperwork Elimination Act (GPEA), the United States (US) Department of Labor (DOL) recognizes the requirement that all Office of Management and Budget (OMB) Forms be made electronically interactive. The CA-1027, Request for Employment Information, has been reviewed with consideration of this goal.

 

Due to the low volume of usage for the CA-1027, this form is not a candidate for electronic submission and the fact that it is not a claim for compensation under the FECA Act makes it a less likely candidate for electronic submission.  The current version of the letter is not set up to allow the claimant to address his or her own employment independently; rather it allows the employer to respond to the US DOL inquiry concerning the employment status of the injured worker. For these reasons, the form will not be placed on the DOL Form Website for claimant downloading.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

The information collected via the CA-1027 is not duplicated anywhere within OWCP or any other Federal agency.

5. If the collection information impacts small businesses or other small entities (Item 5 of 014B Form 83-1), describe any methods used to minimize burden.

 

This information collection does not have a significant economic impact on a substantial number of small entities.

6. Describe the consequence of Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

 

If this information were requested less frequently, claimants could receive compensation to which they were not entitled, creating overpayments which are difficult to recover.

7. Explain any special circumstance.

 

There are no special circumstances impacting this collection.

8. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency's notice, required by 5 CFR 1320.8 (d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments.

 

The last Federal Register Notice inviting comment was published on August 20, 2009.  No comments were received.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

 

No payment or gift is provided to respondents.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulations, or agency policy.

The information collected by this form is maintained in the FECA claim files, which are fully protected under the Privacy Act. The Privacy Act Notice is provided on the form. The applicable Privacy Act system of records is called DOL/GOVT-1. See Web sites: http://www.usdoj.gov/oip/privstat.htm and http://www.dol.gov/sol/privacy/dol-govt-1.htm.

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary; the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

 

This form does not ask questions of a sensitive nature.

12. Provide estimates of the hour burden of the collection of information. The statement should:

Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not make special surveys to obtain information on which to base burden estimates. Consultation with a sample of potential respondents is desirable. If the burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated burden and explain the reason for the variance. Generally, estimates should not include burden hours for customary and usual business practices. Provide estimates of the hour burden of the collection of information. The statement should:

Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not make special surveys to obtain information on which to base burden estimates. Consultation with a sample of potential respondents is desirable. If the burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated burden and explain the reason for the variance. Generally, estimates should not include burden hours for customary and usual business practices.

 

Approximately 500 CA-1027s are sent each year requesting information from private employers.  The information requested on the form is readily available to the respondents.  It is estimated that the form can be completed in an average of 15 minutes, including time to look up the information and write it on the form.  The total burden hours have been calculated to be 125 (0.25 X 500).

 

Because the wage category of the respondent is unknown, we have estimated the cost of the burden hours using the National Average Weekly Wage for production or non-supervisory workers on private nonagricultural payrolls as computed by BLS, or $18.57 per hour. (Rounded to 2,321.00)  $18.57 X 125 hours = $2,321.25. (Reference: http://www.bls.gov/ces/#tables as of March 2009)

13. Annual Costs to Respondents (capital/start-up & operation and maintenance). 

The annual operating and maintenance cost to respondents consists of $235.00 in postage necessary to mail the form (500 x $.47 postage and envelope).

14. Provide estimates of annualized cost to the Federal government.

 

This form is printed by the automated Correspondence Library in OWCP when prompted by a claims examiner.  It is estimated that the time required keying each form, reviewing each completed form and processing the information received takes approximately 20 minutes, or a total of approximately 165 hours (.33 X 500).  An average salary for an OWCP claims examiner is a GS-11, Step 1, earning $27.03 per hour. (165 x $27.03 = $4,459.95).

 

The mailing costs equal $.47 per form for postage and envelope. (.47 x 500 = $235)

 

The total processing costs to the Federal government therefore is

 

Generate/process/postage $4459.95 + 235 = $4694.95 or $4,695.00 rounded.

15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-I.

There is no change in the burden hours since the last submission. However there is an increase in the operation and maintenance cost from $210 to $235 due to an increase in postage.

16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection information, completion of report, publication dates, and other actions.

 

The collected information will not be published.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

 

No exception is requested for the display of the OMB number and expiration date.

18. Explain each exception to the certification statement identified in Item "Certification for Paperwork Reduction Act Submissions," of OMB Form 83-I.

This request is in compliance with 5 CFR 1320.9

1. Collections of Information Employing Statistical Methods:

Not Applicable

The DOL does not seek an exception from the certification requirements.

 

There is no exception to certification.